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Colleges in New Jersey are scrambling to beef up services - including 24-hour suicide response teams - to cope with a steady rise in the number of students with serious mental illnesses.

At least 90 Rutgers University students suffered acute psychiatric episodes in the recent school year, some severe enough to need hospitalization. Overall, as many as 2,000 sought counseling on the school's flagship campus in New Brunswick/Piscataway, said Mark Forest, director of counseling services. They came for a variety of maladies from depression to eating disorders. Many of those diseases manifest themselves in adolescence and young adulthood.

"We have been seeing a general rise in the level of severity of problems of college students," said Forest. Rutgers is hiring three more counselors, to bring the number to 20 in the fall and is developing a crisis response team.

Other colleges in the state also are seeing more students with mental illnesses. The increases mirror national trends. Students who in the past would not have been able to function in college are now able to attend because of advances in medications and schools' willingness to make adjustments for them.

Meanwhile schools work to balance the privacy rights of students with the safety concerns of the entire campus. "We're vigilant," said Dr. Henry Chung, director of the student health center at New York University. The school added staff to its counseling center and began reaching out to students after a spate of seven suicides in 1994. "It's an ongoing challenge."

Young people in the 18-to-24 age category who are not in college are twice as likely to kill themselves as those who go on to higher education. But that still means an estimated 1,100 to 1,400 college students take their own lives each year.

"It's statistically low, but still it's the second-leading cause of death among college students," said Courtney Knowles of the Jed Foundation, which works to prevent suicide and promote mental health among college students.

The effects are, of course, catastrophic for families, and sometimes whole campuses. In the past two years, The College of New Jersey in Ewing has suffered through the suicides of a professor and a student, and the mysterious case of the freshman found dead in the Pennsylvania landfill after he apparently went down a dormitory trash chute.

"We've had an extraordinary run recently here," said Larry Gage, director of counseling at TCNJ "It has a secondary effect for the community. You could feel the aftereffects of that when [the massacre] at Virginia Tech came along," he said. "Here we are hundreds of miles away, but people were kind of raw about that for a while."

The Virginia Tech case has brought a renewed focus to campus mental health issues - the shooter had shown more than a few warning signs: He'd been accused of stalking two female students and threatened suicide in e-mails to a roommate. At least one professor, disturbed by his writing, had asked him to seek counseling, and a judge had declared him an imminent threat and ordered him into treatment. But neither the courts or mental health officials made sure he followed up on the order.

Nationally, and in New Jersey, the massacre has prompted colleges and universities to review both their security and mental health services.

"In an awful way, Virginia Tech has been good for that type of examination," said Gage. However, he and others have cautioned against making the leap in thinking that most college campuses are in a mental health crisis, when, in fact "the majority of students are thriving."

The rise in the number of mentally ill college students, ironically, is because of better mental health services in junior high and high school, the experts say. More students are diagnosed and treated earlier and have a chance to come to college despite their problems. The Americans With Disabilities Act, passed in 1990, mandates that the schools make accommodations for students with both physical and psychiatric disabilities.

This year, for instance, there were 57 students at Ramapo College of New Jersey in Mahwah who requested and got accommodations because of mental illness under the ADA. Anxiety is the leading diagnosis, closely followed by depression and bipolar disorder, said Nancy Carr, director of the office of specialized services.

The help provided to these students ranges from a quiet test-taking environment for students with anxiety disorders to schedule changes for students whose medications make early classes difficult. Some students need private dorm rooms. The health center also aids students in making sure they can get and stay on their medications.

The school also has support groups for students.

"There's always someone there to listen," said the mother of a Ramapo College freshman who was waylaid by depression and suicidal thoughts.

The illness, she said, was triggered by some of the common stressors of college life - a partying roommate and rigorous course work. Her son spent more and more time studying alone in his room.

"Parents have to reach out and keep the lines of communication open," she said. "You can't tell them to toughen up, because they're falling apart. It's a chemical imbalance in the brain and people have to understand that."

Her son completed the year with the help of medication and counseling. He managed a respectable 3.25 grade-point average and looks forward to next semester, she said.

This student and others like him were not required to report their conditions to their schools but did so voluntarily.

"Our policy is students cannot be asked when they come to school if they have a mental health issue," said Linda Smith, director of services for students with disabilities at Montclair State University. "But we've seen, as national trends have shown, there has been a tremendous increase in the number of students who disclose mental illness."

At Montclair, 176 students sought accommodations for psychiatric disabilities during the past school year, Smith said. The school also has a mentoring program for students with psychiatric issues, and students have started a chapter of Active Minds, a mental illness advocacy group.

"When you have a mental illness sometimes you feel that you're the only one," said one student who suffers from bipolar disorder. She said the advocacy group provided "a place to find comfort and friends." And she credited Montclair's special services and her own diligence about staying on her medications with helping her graduate this spring.

Trigger mechanisms

Experts say that for the most vulnerable students, the hyper-competitiveness of college admissions can sometimes trigger a crisis. Staff from both Ramapo and TCNJ say that as the colleges have become more selective, they see more students suffering from anxiety.

The competitiveness also can be a barrier to students getting help. "All through high school these kids didn't have the room to be seen as anything less than competent," said Ann Haas, research director for the American Foundation of Suicide Prevention. "They land at a good school, it comes after years of making themselves look good, and there is no room for imperfection," Haas said. "They're miserable and they know they are miserable but they can't ask for help."

Generally, there are a number of studies pointing to college students feeling more stressed and depressed. In a recent survey, the American College Health Association found that 16 percent of students report having been diagnosed with depression, up from 10 percent in 2000. That survey listed stress as the No. 1 "impediment to student performance," and found that nearly one in 10 students had seriously considered suicide. That study found nearly 40 percent of students had, at times, felt too depressed to function. Another study places that number at closer to half.

Still, only about 9 percent of college students seek counseling on campus. Campus mental health advocates increasingly have been reaching out to students through events like depression screening days.

Most campus counseling centers offer relatively short-term treatment - no more than a dozen visits. Because of the increased seriousness of student problems, counselors said they are making many more referrals for off-campus treatment.

Schools continue to grapple with how much is too much, or not enough, intervention.

Last summer, Hunter College of the City University of New York settled for $65,000 with a student banned from its dorms after an attempted suicide. She had filed suit claiming the ban violated a federal law protecting disabled people from discrimination.

Other schools have been faulted for not doing enough.

The family of a female student from Essex County - who died in a dorm room fire in 2000 that was thought to be a suicide - got an undisclosed amount from the Massachusetts Institute of Technology last year. The family claimed that MIT staffers were aware of their 19-year-old daughter's suicidal thoughts, but didn't tell them and failed to provide proper mental-health services.

Federal privacy laws prevent schools from notifying parents, but counselors say they can often work around those constraints.

"If a student comes for counseling, it's confidential unless they are a danger to themselves or others," said Glen Sherman, former director of the counseling center and now a vice president at William Paterson University in Wayne. "Certainly in light of Virginia Tech, but for us even before that, our thought was that counseling is different in a university setting, where you have to take into account the entire community."

In nine of 10 cases, he said, students are willing to go along with the suggestion that their parents be engaged in the treatment. Also, students living in residence halls sign a contract that stipulates their parents will be notified if they wind up in an emergency room.

"You have to weigh things on an individual basis," said Alice Mills, director of counseling at Fairleigh Dickinson University. "You have to look at what's in the best interest of the students. ... You usually can find a way to deal with it."

Stigmas remain

Although the stigma surrounding mental illness has lessened over time, it is still present. "Depression and suicide is often swept under the rug," said Haykun Lee of Clifton. Lee and his siblings took part in a suicide awareness march in Central Park earlier this month. They wanted to find closure - and raise awareness - after the 2001 suicide death of their cousin, a 20-year old Rutgers sophomore. "This is an issue that we should deal with and talk about."

Late last year mtvU and the Jed Foundation launched an effort called Half of Us - a television and Internet campaign to raise awareness of mental health issues on campus and connect students to the right resources. Its creators hope the campaign, which features college students and celebrities talking about their depression and other emotional problems, will also help remove the shame often associated with mental illness.

"What is startling about this is that it is so pervasive yet there is still a stigma about coming forward," said Stephen Friedman, general manager of mtvU. "Our hope is that one day accessing mental health services will be viewed as normal."

The American Foundation for Suicide Prevention has a program in which students can interact online with counselors at their colleges. The program has "enormous potential," said Haas, the research director. "Colleges would be well served to begin exploring some of this," she said. "Like distance learning, it's not such a big step to have distance support or treatment."

E-mail: alex@northjersey.com

(SIDEBAR, page A06)

Glad to be alive? Just say she's 'shocked'

Stacy Hollingsworth was a self-described "middle school geek" and a classic high school overachiever.

She was a top student, tennis player, hospital volunteer. She also was suicidal.

"Even though I'm 23, I'm shocked to be alive right now," she says.

It was right around puberty, 12 or 13, when the suicidal thoughts began to crowd into her consciousness. She'd always been a planner, a list maker. Now she began to plot her own death: Was the ravine steep enough? Were there enough pills to make sure she never woke up? What would do the least damage to her organs so she could still be a donor?

"I've had plans since the beginning of my suicidality," she says. "I've researched tons of ways of dying. I've done my homework.

"I came very close a few times," she says, almost matter-of-factly. "But I'm not impulsive by nature."

She wrote notes to leave behind but told no one of her torment, not even her parents. "They are very, very protective and very loving and I knew they would blame themselves. ... I didn't want to drag them along for the ride."

Her mom, Sharon, said her daughter showed no sign of being anything but a teenager with a "zest for life." She was involved in school plays, founded a pre-med club and even landed a gig as a ball girl at the U.S. Open tennis championships. "Everybody thought she was happy," her mom said.

Stacy applied to good colleges, kept building her résumé and enrolled at Rutgers University in New Brunswick. During her first week of college, she went to a campus counseling center and began therapy but continued to hide her illness from those who loved her.

The suicidal thoughts did not go away. She hoarded prescription pills, confiding to counselors that she planned to swallow a lethal dose. She was hospitalized but told her parents that they hadn't been able to get in touch with her because she was out studying for a calculus exam. Four days into her hospitalization, she finally called them from a hospital pay phone: "Mom, Dad, come quick, I'm in a psych ward."

Stacy was diagnosed with major depressive disorder. Two years of trial-and-error treatment followed. There were 15 different medications, shock treatment and even acupuncture. Some of the treatments had wicked side effects: flu-like symptoms, blackouts, significant memory loss.

She had to drop out of school, losing $15,000 in scholarship money. Finally, there was a medicine that worked, albeit with side effects and severe diet restrictions. She's been on it for two years and is recovering.

There have been good days and bad. During the darkest periods, just getting from her room to the bathroom "feels like somebody has asked you to do a triathalon." She returned to school, this time living at home rather than the dorms. Rutgers provided some extra help, such as a note-taking service for the days she didn't feel good enough to go to class.

"I've improved a lot but, it's been a rocky road and you don't recover overnight," she says. The former Old Bridge High School honors student says of college: "I had to struggle so much just to get through it."

Last year, she did an internship at NASA in Florida. She says she was functioning up to 90 percent then but has dropped back to 30 percent recently.

Stacy clearly is bright and appears bubbly, even upbeat - she speaks in a Jersey-bred rapid fire. But she allows that she has, over a decade, gotten really good at hiding her depression.

"I have my really dark periods, periods of doubt," she says. "There's always that concern that the treatment will stop working ... You have this sense you're on borrowed time."

Her mom is frightened that she won't let on if the suicidal thoughts return. "I live every day knowing it might be the last if she's not telling me the truth," said Sharon Hollingsworth. She supports Stacy's advocacy efforts and hopes that one day, medical advances will free Stacy from depression's vise.

"I'm thankful every night that we still have her," she said. "And I'm thankful that the world still has her because I think she'll do incredible things if she can stay well."

Once an inveterate planner, Stacy is more tentative now. She is focused on graduating college and perhaps pursuing a career in public health. She has started down that road already, becoming a mental health advocate on campus. She founded a Rutgers chapter of the National Alliance for the Mentally Ill and she has told her story in a number of forums, including a video clip on mtvU's Half Of Us Web site. It's important, she says, to get the word out to let suffering students know they are not alone and to help colleges do a better job of getting students the mental health services they need.

"More people are coming into college with mental illness," she says. "You hear about the freak situations [like Virginia Tech]. You don't hear that 10,000 students with mental illness graduate college."

Stacy wants to be one of them. She tries to turn up the volume of the voice deep inside that tells her to go on living. Still, she keeps a suicide plan in reserve.

"I still have a plan, to this day. I can't disclose it because people would find out and then I couldn't act on it."

(SIDEBAR, page A06)

Fast facts

Tips for helping college students:

* Know the signs and symptoms of emotional distress.

* Encourage teens to go to the school counseling center if needed.

* Understand when and if the college will notify a parent about a teen's mental health.

* Find out what mental health services, policies and programs exist and who to contact if a teen is in trouble.

* Make sure college students choose a school where they'll feel the most comfortable.